Abstract
BackgroundA substantial rate of patients with bulimia nervosa (BN) also suffer from Borderline personality disorder (BN + BPD). It is widely unknown how these comorbid patients with BN + BPD present and respond to inpatient treatment. Aims of the study were to examine (1) specific characteristics of patients with BN + BPD at admission, discharge, and during treatment, and (2) differential effects of inpatient treatment for BN vs. BN + BPD.MethodWe analyzed routine data of inpatients admitted for the treatment of BN between 2013 and 2017 in a specialized hospital for eating disorders. (1) Cross-sectional differences were examined with independent t-tests and χ2-tests; and (2) treatment effects pertaining to eating disorders symptoms, depression, psychosocial functioning and general psychopathology with repeated measures analysis of variance.ResultsOf 1298 inpatients (96% female), 13.2% also had a diagnosis of BPD. (1) Patients with BN + BPD had more previous inpatient treatments (p = 0.001), had a longer length of stay (p = 0.003), gained more weight during treatment (p = 0.006), and were more often irregularly discharged (p = 0.018) as well as rated as unfit to work at discharge (p = 0.003). (2) Both groups improved in all examined variables (all main effects treatment p < 0.001). Patients with BN + BPD showed worse symptoms aggregated across admission and discharge (all main effects diagnosis p < 0.05). Patients with BN + BPD showed smaller improvements (interaction treatment×discharge) in depressive symptoms (p = 0.018), perfectionism (p = 0.009), and asceticism (p = 0.035) and discharge scores mostly lay in the range of the admission scores of the BN-only group.ConclusionPatients with BN + BPD improve during intense and specialized inpatient treatment, yet, retain pronounced impairment at discharge despite longer treatment. Treatment needs to be improved and should focus on transdiagnostic symptoms of BN and BPD.
Highlights
A substantial rate of patients with bulimia nervosa (BN) suffer from Borderline personality disorder (BN + Borderline Personality Disorder (BPD))
Of 1298 inpatients (96% female), 13.2% had a diagnosis of BPD. (1) Patients with BN + BPD had more previous inpatient treatments (p = 0.001), had a longer length of stay (p = 0.003), gained more weight during treatment (p = 0.006), and were more often irregularly discharged (p = 0.018) as well as rated as unfit to work at discharge (p = 0.003)
Patients with BN + BPD showed worse symptoms aggregated across admission and discharge
Summary
A substantial rate of patients with bulimia nervosa (BN) suffer from Borderline personality disorder (BN + BPD). It is widely unknown how these comorbid patients with BN + BPD present and respond to inpatient treatment. Meta-analyses estimated one quarter [2] to one third [3, 4] of persons with BN to meet criteria for Borderline Personality Disorder (BPD), which represented the highest comorbidity rate of all personality disorders in all eating disorders. Hessler et al Borderline Personality Disorder and Emotion Dysregulation (2019) 6:1 met criteria for BN, which was the second highest rate after eating disorder not otherwise specified [6]. Only very little is known about the clinical presentation of persons with BN + BPD and their response to treatment
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